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Breast cancer is the leading cause of cancer death in women, and while metastasis is common to areas like the bone, lungs, and brain, it is rare to metastasize to the gastrointestinal tract and especially to the rectum. Due to the rarity of this condition and its resemblance clinically and radiologically to primary gastrointestinal tract tumors, diagnosis and treatment are challenging. We present a case of metastatic lobular mammary carcinoma in a 52-year-old Bahraini woman who presented with an obstructing rectal mass.

Background Breast-conserving surgeries have significantly advanced breast cancer treatment, offering favorable oncological outcomes, enhanced cosmetic results, reduced postoperative morbidity, and better psychological acceptance compared to mastectomy. The introduction of neoadjuvant therapy has expanded the applicability of breast conservation surgery to include locally advanced tumors. Tumor response to neoadjuvant chemotherapy is evaluated using imaging modalities such as breast ultrasound, breast magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT). Accurate prediction of therapeutic response facilitates the planning of surgical and adjuvant treatments. This study aims to compare the diagnostic accuracy of MRI and PET/CT in predicting treatment response to neoadjuvant chemotherapy in breast cancer patients. Methods This retrospective study was conducted at a tertiary care center in Bahrain. A total of 138 patients with locally advanced breast cancer or human epidermal growth factor receptor-2 (HER2) positive, hormone receptor-negative cancers who underwent breast-conserving surgeries between June 2018 and December 2022 were included. The inclusion criteria focused on patients achieving a complete pathological response following neoadjuvant systemic therapy, ensuring a homogenous study population. Patients with hormone receptor-positive early breast cancers or metastatic tumors, ineligible for neoadjuvant chemotherapy, were excluded. Non-responders and partial responders were also excluded from the study. Statistical analysis was performed using IBM SPSS v26.0 (IBM Corp., Armonk, US). Response rates for the imaging modalities and histopathology results were assessed. Agreement between histology and imaging modalities was computed using kappa statistics. Diagnostic performance for predicting \"no residual\" disease was evaluated using the McNemar Test. All tests were two-tailed, with a p-value <0.05 considered statistically significant. Results The study included 138 patients, of whom 73 (52.9%) had an incomplete response or residual disease, while 65 (47.1%) had a complete response or no residual disease according to histology reports. There was slight agreement between post-neoadjuvant MRI and histology results (Cohen's kappa 0.172, p=0.010), while substantial agreement was observed between post-neoadjuvant PET/CT and histology results (Cohen's kappa 0.614, p=0.000). PET/CT demonstrated a higher sensitivity of 93.8% (p<0.001) and a specificity of 68.5%. Although MRI was more specific, the positive predictive value was comparable for both PET/CT and MRI. Conclusion PET/CT shows higher sensitivity and can serve as an early marker for predicting complete pathological response in post-neoadjuvant breast cancer patients. However, the prediction of residual disease is optimized by combining both MRI and PET/CT as diagnostic modalities.

Abstract Cystic hypersecretory lesions of the breast are a spectrum of conditions ranging from cystic hypersecretory hyperplasia with atypia and invasive cystic hypersecretory carcinoma (CHC). It is a subtype of ductal carcinoma of the breast. The tumour is very infrequent and hence, extensive literature is limited. This culminates in the fact that it does not feature as part of the WHO classification of breast tumours. However, a good knowledge about its distinct pathological features can avert misdiagnosis and help differentiate CHC from other conditions. Thus far, only 22 cases of invasive CHC have been reported, of which 3 were microinvasive. Only 7 cases of axillary lymph node metastasis have been documented. We report a case of invasive CHC of the breast that was metastatic to the axilla and refractory to neoadjuvant chemotherapy. Our case report aims to add to the literature on the disease, aiming to support large-scale studies in the future in order to elaborate on its clinical and biological characteristics.